1) A 9-year-old female has uncontrolled bleeding after having a tooth pulled a the dentist. She has a history of prolonged bleeding following minor trauma to the skin. Her father also has similar issues. Physical exam reveals oral mucosal petechiae and bleeding at the site of tooth removal. Labs: normal platelet count. prolonged bleeding time, and normal PT. Platelet aggregation studies reveal lack of in vitro aggregation when Ristocetin is added. Which of the following is the most likely diagnosis? a) Aspirin ingestion b) Bernard-Soulier syndrome c) Glanzmann thrombasthenia d) Hemophilia B e) von Willebrand disease 2) A 14-year-old female complains of prolong bleeding during menses for the last 2 months. She and her brother tend to "bleed easily" with several nosebleeds. Physical exam demonstrates pallor, occasional petechiae on the skin and in the mouth. An in vitro platelet aggregation study is performed. Addition of agonists (ADP, collagen) show absent aggregation. The physician suspects Glanzmann thrombasthenia. Which of the following is most likely defective/deficient in this patient??  a) Clotting factor IX b) Glycoprotein Ib c) Glycoprotein IIb/IIIa d) Platelet count e) von Willebrand factor 3) A 9-year-old boy develops petechiea and purpura on the trunk and arms. He recently had a viral upper respiratory tract infection. Platelets are noted to be markedly decreased. The physician suspects immune thrombocytopenic purpura. Which of the following most likely contributed to the thrombocytopenia in this patient? a) ADAMTS13 deficiency b) Aspirin affect c) Bone marrow dysfunction d) Liver disease e) Splenic macrophage remove platelets 4) A 6-year-old child is seen in the clinic. The physician notices a large hematoma in the right thigh. He is smiling, active, alert, and interactive. The mother states that he had fallen yesterday and it has become larger. Physical exam is unremarkable except for the hematoma. Which of the following would the physician consider next? a) Call child protective services for concerns of physical abuse b) Order a platelet count to consider immune thrombocytopenic purpura c) Order prothrombin test (PT) to consider a clotting disorder d) Order assay for clotting factors VIII, IX, XI to consider hemophilia e) Treat with recombinant von Willebrand factor

Bleeding disorders

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